Forbes’ Matt Herper — On More Self-Enlightened, Sensible Pricing, For The “New Wave” In Immuno-Oncology

As most of the later-breaking data from ASCO here in Chicago is digested, Mr. Herper has a very well thought out piece up this Sunday morning, on the promise — and the strong incentives, now emerging on pricing — for these breakthrough therapies, across an astonishingly wide array of cancers. Do go read it all.

For its part, the governing body of ASCO itself has put out a deeply detailed white-paper on what should happen with cancer therapy pricing — arguing against the straight fee for service model (summary press release here — we will have more in future posts, on this). Given that these two candidates alone are likely to cost insurers and other payers close to $30 billion a year by 2020, now truly is the moment to think about how we all will pay for these soon-to-be amazing survival stories.

. . . .[The BMS oncology studies] results look very different when they are stratified by whether the tumors churned out a protein called PD-L1 (for programmed death receptor ligand one). Opdivo and Merck’s Keytruda both block PD-1, which binds to PD-L1; blocking this connection allows white blood cells to go kill tumor cells. It stands to reason that these drugs will work better when there’s a lot of PD-L1 being made.

That’s exactly what happened. When tumors had lots of PD-L1, the progression-free survival was the same whether the patient got Opdivo alone or the combo – 14 months. But in patients whose tumors were low in PD-L1, it was a different story. Patients who only received Opdivo had a progression-free survival of just 5.3 months, while for those who got the combination it was 11.2 months, a 58% decrease in the risk of disease progression.

This could be a boon for rivals like Merck and Roche, who have used PD-L1 testing as a major part of their strategy for testing their PD-1 drugs and catching up to Bristol. But both Atkins and Jedd Wolchok, who is presenting the new results here at ASCO, argue against that interpretation – and say that they intend to give the combination to any melanoma patient who can handle the side effects. . . .

This is truly a heady moment in the history of science. And I agree, about reforms on pricing for cancer therapies. We will watch the approaching “event horizon” — very closely now.